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  <title>《牙周刮治基础与高级根面刮治》读书笔记20:模块11：技术基础：刮治施力(Technique Essentials:Instrumentation Strokes) | 赵瑜敏的口腔医学专业学习博客</title>
  








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        <p><strong>模块11：技术基础：刮治施力(Technique Essentials:Instrumentation Strokes)</strong><br>刮治施力是移动牙周器械工作末端通过牙齿表面的过程。有垂直向，水平向和倾斜向三种用力方向。有三种用力方式：评估、去除牙石、根面平整。每一种方式都有其独特的特点和功能。<br><strong>Section1:器械施力(The Instrumentation Stroke)</strong><br>牙周器械的工作末端相对牙齿表面的运动过程称为器械施力(instrumentation stroke)。器械施力用来评估牙齿表面的特性（比如龈下牙石的位置）以及从牙齿表面去除菌斑生物膜和牙石。<br>①刮除牙石时，工作末端需要向冠方移动以从牙面上去除牙石。<br>②探针用一系列轻的，滑动式的施力方式通过牙齿表面，以探测牙齿表面的牙石。<br>③一个重要的原则是器械的工作末端不应该与龈沟或牙周袋基底的软组织接触，因为这会损伤结合上皮。<br>施力方向：有3种不同的方向，取决于牙齿表面的形态。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0097-yzgzjc20/01.png"><br>①垂直和倾斜方向用力总是应该被用在从软组织或牙周袋基底向冠方的运动方向。<br>②横向用力大多用在后牙的线角区域或者前牙的中线区域。一个很重要的问题是注意在横向运动时器械的工作末端不要与软组织结合上皮接触。<br>③混合方向用力(Multidirectional strokes)：结合使用所用3种用力方向。在从牙根表面去除菌斑生物膜时非常有用。<br>A.每次用不同的方向来施力。<br>B.这种技术确保了牙根面的每处的菌斑生物膜都能被清除。<br>施力的形式根据目的来改变。牙周器械用来评估牙根表面、去除菌斑生物膜和牙石、以及平整根面以利于软组织愈合。每个目的需要不同的施力方式。即有三种用力方式：探诊、刮治和根面平整。<br>1.评估：评估牙根表面特性。<br>也叫探诊用力。用来定位牙石或其他龈下牙齿表面附着物。探针光滑的工作末端和延展的柄帮助医生获得相关的触觉信息。主要用来定位龈下牙石，并在刮治后再评估。在去除牙石的过程中，用刮治器采用探诊用力来定位牙石。当所有探测得到的牙石均被去除以后，应该使用探针再探查是否有牙石。探针比刮治器更能准确的探查到牙石。探诊用力的特点是：手指放松采用改良握笔式方法握持。靠在牙面上轻轻用力，长程用力，而不是像刮治一样短程用力。<br>2.刮治用力：去除龈上和龈下牙石。<br>使用镰形刮治器，通用和区位专用刮治器去除牙石。是一种非常短的，有控制的，使用持续的压力将器械工作端咬合在牙面上的施力方式。支点手指在施力期间支持手和器械。在施力开始时，支点手指向下压牙齿。每次施力是一个工作端的轻微的运动。工作端只移动数毫米。在每次用力后，医生暂停然后使用较轻的力来评估是否将牙石去除掉了。在没有牙石的牙面上不要使用刮治力。<br>3.根面平整力：平整根面以利于组织愈合。<br>用来去除残余的牙石，菌斑生物膜，以及其毒性物质。残余的牙石时非常小的残留在牙根表面的牙石，可以用较轻的力量从牙根表面刮除。其特点为：使用中等压力使器械切割边缘与牙体牙骨质相对，用刮削的力来平整根面。力的作用时间要稍微长于刮治用力。保护牙骨质是龈下刮治的一个重要的目标。牙骨质的一个重要作用是为牙周膜纤维附着于牙根表面提供支持。研究表明完全去除牙骨质会使牙本质小管暴露，牙周袋内的细菌会进入牙髓内。<br>4.保留牙骨质不应该与未能去除牙石相混淆。<br>牙周治疗的目的是彻底去除牙齿表面的牙石和细菌产物。牙石总是覆盖着活的细菌生物膜，与牙周持续感染相关。<br><strong>Section2:在刮治过程中的压力的使用(Use of Pressure During Instrumentation)</strong><br>器械用力的三种压力方式：①改良握笔式握持使手指的握持压力；②稳定手部的支点的压力；③刮治用力时的侧向对牙面的压力。<br>在刮治时三种用力方式应该平衡。<br>初学者常犯的错误是持续的用力。这是一种坏习惯。<br>三种需要使用压力的场景：①测量需要使用的力量(Gauge the Amount of Pressure)：使用尽可能小的力量完成。②只用可以确保的压力：在刮治用力时使用，绝不要在两次刮治之间使用压力。③在每次刮治用力后放松。<br>练习：刮下颌第一磨牙颊侧<br>①准备：建立支点，准备用探诊去探查。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0097-yzgzjc20/02.png"><br>②插入：探针尖端在保持与牙体表面接触的情况下插入龈缘。直到工作末端与袋底结合上皮接触。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0097-yzgzjc20/03.png"><br>③评估用力(Make an Assessment Stroke)：用腕肘的力做探查，在越过牙石时，感受振动。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0097-yzgzjc20/04.png"><br>④使用推荐的技术：轻微用力，手指保持放松，如果握持太紧会影响对牙石的感觉。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0097-yzgzjc20/05.png"><br>⑤停止评估用力。<br>在接近龈缘的地方停止用力。支点手指在用力结束时不应该按压牙齿（your fulcrum finger should Not lift of the tooth at the end of a stroke)<br>不要将探针移出牙周袋。反复插入会损伤牙龈组织。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0097-yzgzjc20/06.png"><br>⑥进行一系列的评估用力<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0097-yzgzjc20/07.png"><br>(总结：有不同的施力方式和方向，要根据目的进行选择。）<br>明天就是春节了，提前祝大家猪年吉祥！明年见！<br>我发文章的三个地方（对，多了一个，计算机方面的文章可能会发CSDN的博客上。所有的文章都会发在github个人博客上），欢迎大家在朋友圈等地方分享，欢迎点“好看”。谢谢。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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